Fractures around Trochanteric Nails: The “Vergilius Classification System”Read the full article
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Swiss Orthopaedics Minimal Dataset: First Pilot Report of Reliability and Validity
Background. The Swiss Orthopaedics Minimal Dataset (SOMD) was launched seven years ago. It is a standardized, generic, and patient-reported outcome questionnaire, comprising ten items (location of disease, pain within the past four weeks, limitations at work/leisure/sleep/autonomy, subjective value of a body part, employment status, work disability (sick leave/pension), and household support). We conducted this study about the SOMD to report its reliability, validity, and clinical applicability. Methods. A retrospective observational cohort study was conducted. The test-retest study population (n = 60; lost to follow-up: n = 7 (12%)) was drawn from three retirement homes (in 2013), while the test study population (n = 14,180; excluded (e.g., duplicates): n = 1,990 (14%)) consisted of patients from a university hospital (in 2014–2017). In the test-retest study population, the same questionnaire was completed twice (at days 0 and 7). In the test study population, only the first questionnaire was included (to avoid duplicates). In a subgroup of the test study population (n = 302), only those patients who completed the SOMD and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the hip within 14 days were considered (to minimize recall bias). Reliability (test-retest and internal consistency), criterion validity for the item of pain, and return rates were analyzed. Results. The test-retest study population (n = 53) showed very high test-retest reliability for all tested items of the SOMD (intraclass correlation coefficient = 0.96–1.00 (95% confidence interval 0.93–1.00), ). The test study population (n = 12,190) revealed good internal consistency reliability for all ten items (Cronbach’s alpha = 0.80). The return rates of the SOMD were improvable (43% in 2016 and 31% in 2017). The subgroup of the test study population (n = 302) displayed a borderline acceptable criterion validity (correlation of the item of pain between SOMD and WOMAC hip: rho = 0.62, ). Conclusion. This is the first report about the validation of the SOMD. A relatively high reliability (test-retest and internal consistency), borderline acceptable (criterion) validity for the item of pain, and improvable clinical implementation were observed. This analysis serves as the basis for a structured modification of the SOMD to improve its value.
Nerve Conduction Studies in Patients with Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation
Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conduction study parameters (latency, amplitude, and conduction velocity) between the patients group and the control group. There was significant prolongation in H-reflex latency of both symptomatic and asymptomatic side in the patients group compared to the control group (). Also, F-wave latencies (F minimum, F maximum, and F mean) of the tibial nerve were significantly prolonged () compared to control. Conclusion. Prolonged H-reflex latency was the commonest encountered abnormality in our study followed by F-wave latencies of the tibial nerve.
Biomechanical Assessment of Three Osteosynthesis Constructs by Periprosthetic Humerus Fractures
Background. Biomechanical stability assessment of 3 different constructs for proximal fixation of a locking compression plate (LCP) in treating a Worland type C periprosthetic fracture after total shoulder arthroplasty. Methods. 27 Worland type C fractures after shoulder arthroplasty in synthetic humeri were treated with 14-hole LCP that is proximally fixed using the following: (1) 1 × 1.5 mm cerclage wires and 2x unicortical-locking screws, (2) 3 × 1.5 mm cerclage wires, or (3) 2x bicortical-locking attachment plates. Torsional stiffness was assessed by applying an internal rotation moment of 5 Nm and then after unloading the specimen, an external rotation moment of 5 Nm at the same rate was applied. Axial stiffness was assessed by applying a 50 N preload, and then applying a cyclic load of 250 N, then increasing the load by 50 N each time, until a maximum axial load of 2500 N was reached or specimen failure occurred. Results. With regard to internal as well as external rotational stiffness, group 1 showed a mean stiffness of 0.37 Nm/deg and 0.57 Nm/deg, respectively, group 2 had a mean stiffness of 0.51 Nm/deg and 0.39 Nm/deg, respectively, while group 3 had a mean stiffness of 1.34 Nm/deg and 1.31 Nm/deg, respectively. Concerning axial stiffness, group 1 showed an average stiffness of 451.0 N/mm, group 2 had a mean stiffness of 737.5 N/mm, whereas group 3 had a mean stiffness of 715.8 N/mm. Conclusion. Group 3 displayed a significantly higher torsional stiffness while a comparable axial stiffness to group 2.
New System for the Classification of Epiphyseal Separation of the Coracoid Process: Evaluation of Nine Cases and Review of the Literature
Objectives and Design. Epiphyseal separation of the coracoid process (CP) rarely occurs in adolescents. In this retrospective case series, we reviewed the data of nine patients treated at our center and those of 28 patients reported in the literature. This injury can be classified into three types according to the injured area: Type I, base including the area above the glenoid; Type II, center including the coracoclavicular ligament (CCL); and Type III, tip with the short head of the biceps and coracobrachialis, as well as the pectoralis minor. Patients/Participants. A total of 37 patients were included in the analysis. Data on sex, age, cause and mechanism of injury, separation type, concomitant injury around the shoulder girdle, treatment, and functional outcomes were obtained. Main Outcome Measurements and Results. Type I is the most common type. The cause of injury and associated injury around the shoulder girdle were significantly different between Type I, II, and III fractures. The associated acromioclavicular (AC) dislocation and treatment were significantly different between Type I and III fractures. Our new classification system reflects the clinical features, imaging findings, and surgical management of epiphyseal separation of the CP. Type I and II fractures are mostly associated with AC dislocation and have an associated injury around the shoulder girdle. Type III fractures are typically caused by forceful resisted flexion of the arm and elbow. Although the latter are best managed surgically, whether conservative or surgical management is optimal for Type I and II fractures remains controversial. Conclusions. We noted some differences in the clinical characteristics depending on the location of injury; therefore, we aimed to examine these differences to develop a new system for classifying epiphyseal separation of the CP. This would increase the clinicians’ awareness regarding this injury and lead to the development of an appropriate treatment.
The Effect of Feedback on Surgeon Performance: A Narrative Review
Surgeons play a critical role in the healthcare community and provide a service that can tremendously impact patients’ livelihood. However, there are relatively few means for monitoring surgeons’ performance quality and seeking improvement. Surgeon-level data provide an important metric for quality improvement and future training. A narrative review was conducted to analyze the utility of providing surgeons direct feedback on their individual performance. The articles selected identified means of collecting surgeon-specific data, suggested ways to report this information, identified pertinent gaps in the field, and concluded the results of giving feedback to surgeons. There is a relative sparsity of data pertaining to the effect of providing surgeons with information regarding their individual performance. However, the literature available does suggest that providing surgeons with individualized feedback can help make meaningful improvements in the quality of practice and can be done in a way that is safe for the surgeons’ reputation.
Initial Rotational Instability of the Tapered Wedge-Shaped Type Cementless Stem
Background. Because the tapered wedge-shaped type cementless stem has a small anteroposterior width and a low occupation rate in the medullary space, postoperative rotational instability and stem subsidence due to inadequate proximal fixation are concerns. The purpose of this study was to clarify the relationship between the rotational instability of the tapered wedge-shaped type cementless stem and femoral canal shape. Methods. A total of 61 primary total hip arthroplasties with the tapered wedge-shaped type cementless stem Accolade® TMZF (11 males, 50 females; mean age 60 years) from January 2012 to June 2015 who underwent computed tomography before surgery and within 4 weeks and 1 year after surgery were evaluated. The preoperative femoral neck anteversion angle, preoperative femoral canal flair index, the degree of postoperative stem subsidence within 1 year after operation, and the degree of rotational change in the stem setting angle within 1 year after operation were investigated. Results. The mean preoperative femoral neck anteversion angle was 32.2° ± 17.8° (0°–69°), and the mean preoperative canal flair index was 3.68 ± 0.58 (2.44–5.55). There were no stem subsidence cases within 1 year after operation. The mean degree of rotational change in the stem from immediately to 1 year after surgery was −0.4° ± 1.7° (−3°–3°). There was no significant correlation between the canal flair index and the rotational change in the stem. In addition, the mean difference between the preoperative femoral neck anteversion angle and the stem rotational angle immediately after surgery was only 1.3° ± 5.3° (−29°–15°). Conclusions. In all cases, including stove-pipe cases, the degree of rotational change in the Accolade® TMZF stem from immediately to 1 year after surgery was within 3°. In other words, regardless of femoral canal shape, the tapered wedge-shaped type cementless stem has little initial rotational instability.